An interesting correlation between severe pressure sores and one type of wheelchair cushion
New clients come to us for help and they very often indicate they currently have severe pressure injuries. This makes sense because our wheelchair cushions are specifically built to treat pressure injuries. One of the questions we ask on our order form is what brand of wheelchair cushion is the client currently using?
We ask this so we can track the data and see if there is a correlation between any particular type of wheelchair cushion and stage or severity of current pressure injuries.
There are many factors that contribute to the formation of pressure injury so assuming the wheelchair cushion alone is responsible for causing pressure injury is incorrect. None the less, the wheelchair cushion is the only device that directly impacts posterior pressure when the person is sitting. We also know that unrelieved posterior pressure is the primary cause of pressure injury, so it merits investigating any connection between type of wheelchair cushion and severe pressure injury.
For the past 2 years, each time a new cushion order came it and the client indicates they currently have either a stage 3 or 4 pressure injury, we documented and tracked of the brand of wheelchair cushion currently used by that client to look for a possible connection.
The results are startling. Our data indicated an interesting correlation between severe pressure injury and one brand of wheelchair cushion. Our data show that 95% of new clients tracked during this 2- year period that currently had a severe stage 3 or 4 pressure sore, listed their most recent wheelchair cushion brand as a Roho cushion.
Given the vast number of different wheelchair cushions on the market, this data begs an interesting question. Why is there such a high percentage of pressure injuries associated with this one brand of wheelchair cushion for new clients coming to us for help? Is there some attribute associated with that type of cushion performance or construction that bring about a high incidence of pressure injury? To answer that question, we need to first look at the Roho cushion, its physical properties, construction, and features and then you can draw your own conclusions as to prevalence of pressure injury relating to this type of wheelchair cushion.
Physical characteristics of a Roho cushion
A Roho cushion is classified a static air cushion meaning the cushion remains motionless and does not have the ability to move or change pressure points on its own. This is the same for any non-powered static wheelchair cushion.
Being a static cushion, a Roho applies constant pressure to the posterior. This is a problem because constant pressure is the leading cause of pressure sores. Cushions such as a Roho require the wheelchair user to create or supply their own pressure relief to avoid devastating pressure injury.
A Roho is an air only cushion and must be inflated to the correct pressure because too much or too little air can also be dangerous. If too little air, the protection the air provides is compromised and the person can bottom out. If too much air in the Roho, there can be excessive pressure applied to the skin and tissue. Either of these scenarios can also lead to devastating pressure injury.
Roho is a rubber inflatable cushion which uses air as the only cushioning / protection medium. With no other material to provide protection from bottoming out. This is interesting because if there is a leak, the cushion loses all of its ability to protect the user from pressure injury. This characteristic in unique to Roho because none of the other static cushions on the market can rapidly change from suppling some degree of protection to absolutely no protection. Foam, gel, polymer and custom molded cushions have solid materials which provide protection. Solid materials cannot leak into the atmosphere and vanish like gaseous materials can.
Bottoming out is extremely dangerous especially if the seat pan is a sheet of metal and can quickly lead to devastating, potentially fatal pressure injury.
The Roho cushion has no alarm system to alter the user of lost air in the cushion. This is especially disturbing because if the person has no sensation in the posterior, they have no way of knowing if the Roho cushion is flat.
95% of clients coming to us with a severe pressure injury over a 2- year period listed their most recent cushion as a Roho cushion. A Roho cushion is static and applies constant pressure and pressure is the primary cause of pressure injury. In a Roho cushion air is the only cushioning medium protecting from totally bottoming out. Too little or too much air is dangerous and can cause pressure injury. The Roho cushion has no warning device to alert the user of loss of air and a flat Roho will result in totally bottoming out. It all seems obvious, but we advise you to look at the facts and reach your own conclusion about the Roho cushion and prevalence of pressure injury for clients using the Roho cushions. The data and facts seem to support one conclusion.